Abstract / Summary
Abstract Purpose Precise needle placement is vital for effective thermal ablation of liver tumors. Ventilation during anesthesia induces liver movement. This study compares different ventilation strategies and their impact on the movement of right and left inferior liver margins. Materials We conducted a non-randomized crossover study involving 20 patients scheduled for thermal ablation of liver metastases from colon cancer (November 2022–April 2024). Methods Five ventilation modes were evaluated: standard ventilation; low-tidal-volume, high-frequency ventilation; one-lung ventilation; and high-frequency jet ventilation with and without additional normal-frequency jet ventilation. Movement of the inferior liver margins was measured using ultrasound, recording cranio-caudal displacement of the left lobe at the midline and the right lobe at the anterior axillary line. Results Standard ventilation resulted in the greatest movement with 5.8 mm of the left and 7.3 mm of the right inferior liver margin. Low-tidal-volume, high-frequency ventilation reduced movement to 4.0 mm on the left and 4.6 mm on the right side. High-frequency jet ventilation caused the least movement, with 1.2 mm of the left and 0.5 mm of the right margin, the latter comparable to right-sided one-lung ventilation, which caused movement of the right margin of 1.6 mm. Conclusion Liver movement varied by ventilation method. High-frequency jet ventilation and right-sided one-lung ventilation provided the greatest stabilization, low-tidal-volume, high-frequency ventilation reduced movement compared with standard ventilation, and standard ventilation produced the largest movement. These differences may help guide the choice of ventilation strategy in procedures sensitive to organ motion. Trial registration Clinicaltrials.gov ID, NCT05129787 , registered 11/02/2021.